To Eat or Not to- Bulimia Nervosa

shravani dali

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bulimia nervosa

Bulimia nervosa is an eating disorder which is characterized by periods of binge eating followed by a compensatory behavior like purging or the abuse of diuretics or laxatives. They often feel a lack of control over their eating. It usually occurs in people who have a fear of gaining weight. When they engage in excessive overeating they may attempt to use purging for their weight control. According to studies, a bulimic can consume approximately, 20,000 calories in eight hours.

Mental Disorder Vs Obsessive Behaviour

People with bulimia are aware of their problem; however, find it difficult to control their urge of overeating. Bingeing and purging are mostly performed in secrecy, as they are embarrassed by their actions. It is a serious mental disorder and not mere an obsessive behavior which requires intensive treatment.

Unlike those suffering from anorexia, they can maintain a normal weight; however, they do not seem satisfied, and desperately try to lose more weight.  They are also intensely unhappy and dissatisfied with their body size and shape, which may exactly explain why bulimic behavior often takes place in secrecy. The bingeing and purging cycle occurs repeatedly,  several times in a week.  Patients usually have coexisting mental illnesses, such as depression, anxiety, and substance abuse.  According to studies,

Approximately, 1-4% of females have bulimia nervosa, at least once during their lifetime. The prevalence is far less common in males than in females. Most cases are seen in the early 20s.

 Warning signs and symptoms :

  • Recurrent episodes of binge eating or excessive overeating. A typical episode of binge eating presents as follows :

             Eating, large quantities of food, in secrecy for a short period of time (within any 2-hour period).He/she does not have control over eating during the episode. This is followed by inappropriate compensatory behavior such as vomiting, misuse of laxatives or diuretics, fasting, or exercise.

Emotional and behavioral Symptoms

  1. Generally, they reflect behaviors which are inclined towards weight loss and looking pretty or well maintained.
  • Increased trips to the washroom, evidence of vomiting, packages of laxatives or diuretics.
  • Avoids eating around or/with others.
  • Develops particular food habits (eats only one food group)
  • At regular meals, will prefer eating smaller portions.
  • Steals or hides food items.
  • Drinks plenty of water or non-aerated drinks. 
  • Often found wearing baggy clothes 
  • Follows an aggressive exercise regimen
  • Withdrawal from friends and society
  • Stomach seems bloated from fluid retention 
  • Frequent checking out in the mirror for perceived body flaws
  • Extreme mood swings

Physical Symptoms

  1. Noticeable weight fluctuations.
  2. Constant stomach cramps, constipation, acid reflux, etc
  3. Difficulty focusing on work.
  4. Syncope and fatigue
  5. Cold intolerance
  6. Insomnia
  7. Teeth are discolored, stained and eroded.
  8. Has bruises on the back of the hands and knuckles, due to self- induced vomiting.
  9. Skin is dry, brittle nails and hair (lanugo)
  10. Swelling near the jaws (salivary glands)
  11. Pale skin, muscle weakness.
  12. Menstrual irregularities.
  13. Impaired immune system.


The recurrent cycle of binge-and-purge has an adverse effect on the digestive system which may lead to major electrolyte and chemical imbalances. These imbalances can further effect, the heart and other organ functions. 

The body can usually cope up with the stress of eating disorders, which can make the laboratory tests appear normal even if someone is at the risk of death. Electrolyte imbalance is an important risk factor for cardiac arrest.



Psychotherapy involves discussing and counseling of the patient by a mental health professional.

Cognitive behavioral therapy: Enables the patient to get back to normal eating patterns, differentiate between healthy and unhealthy food items, eradicate negative thoughts and focus on positive ones.

Family therapy: This helps the patient’s parents understand their child’s condition more precisely so that they can extend their support and care efficiently.

Interpersonal psychotherapy: This therapy intervenes into the personal relationships of the patient, help them to sort out any grievances and enable them to communicate with their friends and society in a coherent manner.


Antidepressants are prescribed, to help reduce the psychological symptoms of bulimia nervosa. The antidepressant specifically approved by the Food and Drug Administration is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI).

Nutrition education

Dietitians can help in designing a healthy eating plan to achieve the weight goal and moreover, to avoid cravings for junk food. Eating at regular intervals and not restricting the diet is most crucial in overcoming bulimia.


Only if symptoms worsen, the patient is hospitalized.

Lifestyle modifications:

  •  Complete the therapy sessions and strictly follow what is advised, even if it makes you uncomfortable.
  • Educating yourself about the condition is crucial as it will motivate you to stick to your treatment plan.
  • Make sure that you are getting the right nutrition. 
  •  Avoid staying aloof and try socializing more, ask help and advice from peers and elders.
  • Resist the urges to constantly weigh yourself or check yourself in the mirror.
  •  Do not over exercise be cautious about it.
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